A nurse is preparing to administer dextrose 5% in water (D5W) 1,000 mL IV to infuse over 10 hours. The nurse should set the IV infusion pump to deliver how many mL/hr? (Round to the nearest whole number.)

Choice A reason: Questioning death’s reason reflects normal grief, involving amygdala-driven emotional processing and cortisol surges. It does not indicate complicated bereavement, which involves prolonged, impairing despair, disrupting serotonin-mediated emotional recovery after a year.

Choice B reason: Stating life has no meaning a year after loss suggests complicated bereavement, with persistent serotonin deficits and amygdala-driven despair. This indicates unresolved grief, impairing prefrontal cortex-mediated coping and emotional integration, characteristic of prolonged, dysfunctional mourning.

Choice C reason: Questioning God’s role is a normal grief response, reflecting amygdala-driven existential distress. It does not indicate complicated bereavement, which requires persistent functional impairment and serotonin dysregulation beyond the expected grief timeline of one year.

Choice D reason: Self-focused questioning is part of normal grief, driven by amygdala-anxiety and cortisol. It does not signify complicated bereavement, which involves prolonged, debilitating despair and serotonin deficits, impairing recovery and functioning beyond a year.

Choice A reason: Citalopram, an SSRI, increases serotonin levels, requiring 4-6 weeks to upregulate serotonin receptors and modulate prefrontal-amygdala circuits for mood improvement. Explaining this delay addresses patient expectations, reducing frustration and enhancing adherence by clarifying the neurochemical timeline of antidepressant action.

Choice B reason: Increasing the dose after 4 days is premature, as SSRIs like citalopram require weeks to alter serotonin signaling and neural plasticity. Premature dose escalation risks side effects like serotonin syndrome without addressing the expected therapeutic lag, making it an inappropriate intervention.

Choice C reason: Assessing for improvement after 4 days is unlikely to yield significant findings, as citalopram’s serotonin modulation takes weeks to impact mood via prefrontal cortex changes. This approach may reinforce the patient’s frustration without addressing the neurochemical basis of the delayed response.

Choice D reason: Reassuring effectiveness without explaining the delay is misleading. Citalopram’s action on serotonin pathways requires time for receptor upregulation and neural circuit adaptation. This vague reassurance does not educate the patient on the neurochemical timeline, potentially reducing trust and adherence.